Benefits Information & Forms

MEDICAL BENEFITS

Bergen Community College provides eligible employees and their eligible dependents several health care options shown below. Coverage begins after 2 full months of employment.

Preferred Provider Organization Plans (PPO):
A Preferred Provider Organization (PPO) plan allows you to visit any health care professional, in or out of the network. Most in-network services require a co-payment for primary care and specialist appointments. Out-of-network services require a deductible, which must be satisfied before the plan’s coinsurance kicks in. The amount you pay out‐of‐pocket depends on where you receive care. There are no referrals with these PPO plans. Preventative services are covered at 100% when visiting a physician within the network. The PPO plans are listed below:

Horizon Blue Cross Blue Shield of New Jersey

NJDirect Zero

NJDirect10

NJDirect15

NJDirect1525

NJDirect2030

NJDirect2030

Aetna

Aetna Freedom Zero

Aetna Freedom10

Aetna Freedom15

Aetna Freedom1525

Aetna Freedom2030

Aetna Freedom2035

Health Maintenance Organization Plans (HMO):
A Health Maintenance Organization (HMO) provides in-network benefits only with a copay for most services. Preventative care is covered 100% with no copay. Your Primary Care Physicians (PCP) is your first point of contact for any of your health needs and you need a referral to a specialist whenever you need one. The HMO plans are listed below:

Horizon Blue Cross Blue Shield of New Jersey

Horizon HMO

Horizon HMO1525

Horizion HMO2030

Horizon HMO2035

Aetna

Aetna HMO

Aetna HMO1525

Aetna HMO2030

Aetna HMO 2035

Please Note: The copayment for the PPO and HMO medical plans is the number listed after the plan name. For example, NJDirect10, there is a $10 copay for both the Primary Care Physician and Specialist and for NJDirect1525, there is a $15 copay for Primary Care Physician and $25 copay for a Specialist.

High Deductible Health Plans (HDHP):
A High Deductible Health Plan (HDHP) provides benefits once you reach your deductible. Preventive care and certain screenings are paid by the plan without the deductible. Once the deductible is met, you pay only coinsurance until you reach an out-of-pocket maximum at which point services are covered in full by the plan. Participation provides HSA to put aside pre-tax money to use for qualified expenses. The HDHP plans are listed below:

Eligible Dependent Children Duration of Medical Coverage:
An eligible dependent child will be eligible to remain under the medical coverage until the end of the calendar year (12/31) in which he/she turns 26 years old.

Accessible from your computer, tablet or smartphone, the website provides all the information you need to make informed decisions as well as contact information. Plan information and Summaries of Medical Benefits and Coverage can be found at:www.nj.gov.oe

Click on “Active Employees”

BCC employees are part of the Local Education Employees group with the State (SEHBP)

If you require the services of a relay operator, please dial 711 and provide the operator with the following phone number: (609) 292-6683. You will then be connected to a Client Services phone representative for assistance.

DENTAL BENEFITS

Coverage is through Delta Dental of New Jersey and is available for Employee plus one eligible dependent. *Coverage for more than one eligible dependent is available for purchase at additional cost. Coverage begins on the first of the month after 2 full months of employment.

OTHER BENEFITS

Flexible Spending Account (FSA)
The College offers the Flexible Spending Account plan options for all full-time, benefit-eligible employees through Horizon Blue Cross/Blue Shield FSA. This is a separate benefit plan from the medical insurance through Horizon Blue Cross/Blue Shield.

Flexible Spending Accounts run on a calendar year basis and are a convenient, pre-tax way to pay for eligible out-of-pocket health care expenses (including medical, dental and vision expenses) as well as dependent care expenses. Money from each paycheck is deposited into your account(s) before federal income, Social Security and Medicare taxes are withheld. You are then reimbursed for eligible expenses using before-tax dollars from your account(s). The yearly contribution limit is $2,650 for the medical FSA and $5,000 for dependent care. For more information, please visit Flexible Spending Account (FSA) and FSA Calculator for an online version of the worksheet. Participation in the plans is voluntary.

OTHER HELPFUL INFORMATION:

Qualifying Events During the Year

To change your coverage during the year it must be due to a qualifying event and you must contact Human Resources within 60 days of the qualifying event(marriage, enters into a civil union or domestic partnership, birth, adoption and changes in family status involving the loss of job; divorce; dissolution of a same-sex domestic partnership; or changes in dependent status.)

Social Security
The Web site contains information on retirement, disability and survivors benefits to workers and their families, in addition to the administration of the social security income program.

Terms You Need to Know:

Coinsurance
The sharing of certain covered expenses by the plan and the plan participant. For example, if the plan covers an expense at 80 percent (the plan’s coinsurance), your coinsurance is 20 percent of the provider’s charge.

Coinsurance Limit
The coinsurance limit is the maximum that you must pay out-of-pocket for your coinsurance share each calendar year.

Copayment (copay)
The specified dollar amount or percentage required to be paid directly to an in-network provider.

Deductible
The amount of covered expenses that a member must pay each plan year before the plan begins to pay benefits.

Dependent
A member’s spouse, civil union partner, same-sex domestic partner (as defined by P.L. 2003, c.246), or child(ren) under the age of 26. Children include natural, adopted, foster, and stepchildren. If a covered child is not capable of self-support when he or she reaches age 26 due to mental illness or a physical disability, coverage may be continued subject to approval.

In-Network Provider or Participating Provider
Any physician, hospital, skilled nursing facility, or other individual or entity involved in the delivery of health care or ancillary services that contracts to provide covered services to plan participants for a negotiated charge.

Out-of-Network Provider
This term generally is used to mean providers who have not contracted with a health plan to provide services at negotiated fees; or, with an HMO, an in-network provider who is furnishing services or supplies without a referral from the patient’s PCP.

Out-of-Pocket Maximum
The out-of-pocket maximum is the maximum amount you must pay toward covered medical expenses in a calendar year. Once you reach this maximum, the plan pays 100 percent of your remaining covered expenses for the rest of the year.

Urgent Care
Services received for an unexpected illness or injury that is not life threatening but requires immediate outpatient medical care that cannot be postponed. An urgent medical condition requires prompt medical attention to avoid complications and unnecessary suffering or severe pain, such as a high fever.